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High Incidence of Second Primary Tumours in Patients With Low-Stage Tumours of the Larynx and Oral Cavity Suggests Need for Closer Follow-Up: Presented at AAO-HNSF By Mary Beth Nierengarten CHICAGO -- September 24, 2008 -- Patients treated for low-stage head and neck squamous cell carcinoma (HNSCC) of the larynx and oral cavity have a high incidence of second primary tumours, researchers reported here at the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF) 2008 Annual Meeting & OTO EXPO. These findings raise questions as to whether these patients should be followed more closely, said investigator Erlend Rennemo, MD, Department of Otolaryngology, Head and Neck Surgery, Rikshospitalet, Oslo, Norway. Patients with low-stage tumours of the larynx and oral cavity are often not followed as closely as higher stage tumour patients due to their good survival rates and low treatment morbidity, Dr. Rennemo said. "Nevertheless, these are the patients that are prone to develop a new tumour." In the study, presented on September 21, investigators found a high correlation between the development of second primary tumours in patients with low-stage (I or II) primary disease, as well as younger patients (<66 years old); those with primary tumours in the larynx and oral cavity; and those with good response to treatment of their initial tumour. To identify patients at high risk of developing a second primary tumour after successful treatment of a primary tumour, Dr. Rennemo and colleagues conducted a retrospective analysis of data from 2,063 patients who had been treated over a 15-year time period for tumours of the hypopharynx, larynx, oropharynx, and oral cavity. They found a significant correlation between the development of a secondary tumour and less advanced initial disease based on both tumour (T) and node (N) classification of disease stage. Secondary tumours developed in 21% of patients with T1 tumours, in 21% of patients with T2 tumours, in 16% of patients with T3 tumours, and in 12% of patients with T4 tumours (P < .05). Similarly, secondary tumours developed in 21% of patients with N0 tumours, in 13% of patients with N1 tumours, in 9% of patients with N2 tumours, and in 6% of patients with N3 tumours (P < .05). Significantly more younger patients also developed secondary tumours, with 19% of patients <66 years old compared with 15% of patients >66 years old (P = .02). The development of a secondary tumour was also significantly associated with an initial index tumour in the oral cavity or larynx (19% and 18%, respectively) compared with the oropharynx or hypopharynx (14% and 8%, respectively) (P < .05). Results also show that prognosis was poor after diagnosis of a second primary tumour, with a median survival of 12 months. According to Dr. Rennemo, these results raise the question of whether patients with low-stage disease should be followed more closely than they are followed currently, as well as whether clinicians should be more reluctant to treat primary tumours with radiotherapy in these patients in the event that this treatment modality may be needed later to treat a second primary tumour. "The take-home message is that the possibility of a second primary tumour should be borne in mind when following up patients with earlier low-stage HNSCC," said Dr. Rennemo. [Presentation title: The Impact of Second Primary Tumours on Survival. Poster S151] E-mail this page to a friend or colleague! To print, use this version